Oncology medications just got simpler… or did they?

April 16, 2018

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The names of many new oncology drugs may trip a few tongues – Tagrisso, Xalkori, Mekinist, and Ninlaro come to mind – but the drugs themselves are a lot simpler than their predecessors, for one important reason: they are taken orally.

Currently available oral oncology medications cover a range of indications, from multiple myeloma and metastatic melanoma to castration-resistant prostate cancer and small-cell lung cancer. There’s even an oral medication for graft-versus-host disease, a potentially life-threatening complication of stem cell transplant treatment. In the study that led to approval of the medication (Imbruvica, Janssen Inc.), 67% of patients had a complete or partial response to the drug.1 A clinical trial of the drug has also given legendary hockey player Paul Henderson a new lease on life 2 – a testament to the life-changing potential of these medicines.

The last few years have seen an explosion in this pharmaceutical niche, and the trend continues to burn hot: based on recent figures from Canadian Cancer Action Network, 51% of oncology indications – that would be 190 molecule/disease combinations – in the pipeline involve oral medications. Head and neck, gastrointestinal, genitourinary… it seems there will soon be an oral medication for every type of cancer. Best of all, some of these agents can target specific cancer genes, meaning they have the potential to choke off the carcinogenic process at its source – what researchers call precision medicine – and significantly prolong survival.

These innovations could not come at a better time, given the rising prevalence of cancer in our aging population. As it stands, about half of all Canadians will develop cancer in their lifetimes, and 60% of these individuals will live at least five years beyond their diagnosis.4 For these long-term survivors, cancer takes on the character of a chronic disease.

It goes without saying that the oral route makes patients’ lives immeasurably simpler. Instead of going to hospitals or clinics for treatment, they can take the medications at home. No scheduling challenges, risk of injection site reactions, or lengthy waits during infusions. This means patients can lead a more normal lifestyle and, perhaps more important, feel more normal.

The convenience of pills comes with some downsides, though: without scheduled treatments, patients may fail to take their medications as prescribed – and thus raise the risk of relapse.5,6 Some patients may also perceive pills as less potent than infused medications, which could further impact adherence. The shift to oral treatments also puts the onus on patients to access their treatments at community pharmacies or via home delivery from specialty pharmacies, presenting a variety of distribution challenges – and opportunities – for manufacturers.

That’s why patient support programs (PSPs) and targeted distribution strategies are no less important for oral cancer treatments than for their infused counterparts. As the saying goes, the devil is in the details – which we explore in the next two articles.


References

1 Janssen Imbruvica news release, Oct. 30, 2017. https://www.janssen.com/canada/sites/www_janssen_com_canada/files/imbruvica_cgvhd_newsrelease-_final_eng.pdf

Globe and Mail, Dec. 3, 2014: https://www.theglobeandmail.com/sports/hockey/paul-henderson-says-cancer-treatment-is-a-game-changer/article21941135/

3 CADTH cancer drug pipeline information. http://www.ccanceraction.ca/wp-content/uploads/2017/04/HTA-Pipeline-April-3-2017-PDF-1.pdf

4 Canadian Cancer Society 2017. http://www.cancer.ca/en/cancer-information/cancer-101/cancer-statistics-at-a-glance/?region=on

5 Jabbour EJ et al. Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia. Am J Hematol 2012; 87:687–691.

6 Ruddy K et al. Patient adherence and persistence with oral anticancer treatment. CA: A Cancer Journal for Clinicians 2009; 59:55-56

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